Myopia management is not a new thing, but it certainly has become the cool kid in town. Over the last 20 years, we have seen treatments explode, and today’s options are a dream for those of us who have been doing it for a long time.

A great debate around myopia management is not just in the treatment but in the measurements and management of progression. While we want to keep kids’ eyes from becoming myopic, should our focus be on the prescription of the eye or on what causes the prescription—namely, the axial length of the eyeball? While the refraction of children is the main issue for kids and caregivers, because they do not want kids’ vision to be blurry, it’s the larger eyeball that leads to the damage and is the cause of pathology. As such, are we at a place today at which we can conclude that axial length is the required method of monitoring how we manage myopia progression?

All Signs Point to Yes

Scientists and purists would argue that the answer is yes. And I (Dr. Kading) am very delighted that they think so. This stance requires researchers to complete studies and to make advancements that prove that the treatments that we use in practice slow not only the refraction but also the axial length.

As we read over the research, time and again, we see a strong correlation that refractive error retardation and cessation often matches that of axial length growth (Wolffsohn et al, 2019). While there are exceptions, this holds true in most of the research that I have reviewed.

So do we ignore axial length in our practices? By no means. While we do not believe that monitoring axial length is the normal, we do believe that it will become the normal, hopefully within the next five years. Worldwide, practitioners have incredible instruments that measure axial length. These instruments are becoming more mainstream, and some of them even measure refraction, horizontal visible iris diameter, and keratometry in addition to axial length. Topographers are getting axial length incorporated into them. We should also be seeing optical coherence tomography technology and advanced refraction instruments begin to incorporate axial length as a feature. Our suggestion: get the axial length feature on the next instrument that you purchase that offers it as an add-on. Whether you do myopia management in your clinic or refer it out, having a way to measure the axial length of your patients’ eyes will become increasingly valuable to you.

Making Progress

As we progress past our couple of years of enlightenment on the importance of doing myopia management, we will enter a new normal of measuring its success and maximizing our results. We will see technology come into our practices that allows us to measure and then make suggestions about how to modify our myopia management plan to gain the greatest amount of treatment that we can. The more data that we have at that point in our future, the more effective we will be with determining a patient’s treatment.

The Verdict

If you are wondering whether we are there yet, the answer is no. However, if you are not moving in the direction of measuring axial length within the next few years, you will no longer be normal. CLS

For references, please visit www.clspectrum.com/references and click on document #316.